NPIMap

Organization Active NPI

Teche Action Board, Inc.

Doing business as Teche Health SBHC @ East St. John High

  • Federally Qualified Health Center (FQHC)
  • Reserve, LA
National Provider Identifier
1255788428
Registry record updated Aug 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TECHE ACTION BOARD, INC.
Doing business as
Teche Health SBHC @ East St. John High
Practice address
1 Wildcat Dr
Reserve, LA 70084-5800
Phone
(337) 828-2550
Fax
(337) 355-2335
NPI assigned
May 18, 2016
Last updated
Aug 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gary M Wiltz, M.D.NPI 1477596351
Title
Ceo
Phone
(337) 828-2550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1 Wildcat Dr
Reserve, LA 70084-5800

Mailing address

1115 Weber St
Franklin, LA 70538-4124
Phone (337) 828-2550

Other identifiers 1

IdentifierTypeStateIssuer
2426273MedicaidLA

Other names 1

  • Teche Health SBHC @ East St. John High Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041109000792 LA Part B Supplier - Clinic/Group Practice 0648163980 Receives reassigned benefits from 39 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: La Place, LA; Vacherie, LA; Thibodaux, LA; Reserve, LA; Pierre Part, LA; Morgan City, LA; Houma, LA; Gramercy, LA…
O20161111001654 LA Part A Provider - Federally Qualified Health Center (FQHC) 0648163980 Practice locations: Reserve, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255788428. Details of each certification follow.

Federally qualified health center certification: CCN 191958

Legal name
TECHE ACTION BOARD INC
Doing business as
TECHE HEALTH SBHC @ EAST ST JOHN HIGH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 2, 2016
Last certification
Nov 2, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1994 in LA
Enrollment address
10 Wildcat Drive
Reserve, LA 70084-5800

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Teche Action Clinic15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Willie Rack Individual Corporate DirectorBoard Member Apr 10, 2014
Howard Castay Individual Corporate DirectorBoard Member Apr 10, 2014
Berryl Broussard Individual W-2 Managing EmployeeCheif Legal Officer May 3, 2021
Thomas Dardar Individual Corporate DirectorBoard Member Apr 10, 2014
Barbara Hills Individual Corporate OfficerSecretary Apr 10, 2014
Eugene Dial Individual Corporate DirectorBoard Member Jan 3, 2022
Leroy Willis Individual Corporate OfficerPresident Apr 10, 2014
Edna Lyons Individual Corporate DirectorBoard Member Apr 10, 2016
Darrell Jupiter Individual Corporate DirectorBoard Member Apr 10, 2014
Denise Pitts Individual Corporate DirectorBoard Member Apr 10, 2014
Nikina Vilcan Individual W-2 Managing EmployeeCfo Aug 3, 2020
Rose Dorsey Individual Corporate OfficerTreasurer Apr 10, 2014
Gary M Wiltz Individual Corporate DirectorCeo Apr 10, 2014
W-2 Managing EmployeeCeo Apr 10, 2014
Operational/Managerial ControlCeo Apr 10, 2014
Donnie Frizzell Individual Corporate DirectorBoard Member Apr 10, 2014
Athan J Olivier Individual W-2 Managing EmployeeCoo Apr 22, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Gary M Wiltz, M.D.
    • Internal Medicine Physician
    • Franklin, LA
    • NPI 1477596351

    Corporate Director, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754870400000",
    "number": "1255788428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 WEBER ST",
            "city": "FRANKLIN",
            "state": "LA",
            "postal_code": "705384124",
            "telephone_number": "337-828-2550",
            "fax_number": "337-355-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WILDCAT DR",
            "city": "RESERVE",
            "state": "LA",
            "postal_code": "700845800",
            "telephone_number": "337-828-2550",
            "fax_number": "337-355-2335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TECHE ACTION BOARD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-18",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A",
        "authorized_official_last_name": "WILTZ",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-828-2550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2426273",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teche Health SBHC @ East St. John High",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reserve, LA

Sources for this page

Verify at the official NPI Registry.